Symptoms Assessment and Screening for Laryngeal Injury Post-extubation in ICU

ICU拔管后喉损伤的症状评估和筛查

• 批准号: 9792391
• 负责人: Martin Bruce Brodsky
• 金额: $ 60.38万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-25 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9792391
• 关键词: Absence of pain sensation; Acoustics; Acute respiratory failure; Age; American; Artificial Respiration; Breathing; Categories; Chronic; Clinical; Communication; Critical Care; Critical Illness; Data; Development; Early identification; Edema; Evaluation; Exhibits; Fatigue; Foundations; Goals; Granuloma; Guidelines; Hoarseness; Hour; Image; Injury; Intensive Care Units; Intervention; Intratracheal Intubation; Intubation; Knowledge; Language; Laryngeal Injury; Laryngoscopes; Laryngoscopy; Larynx; Life; Light; Literature; Measures; Mechanical ventilation; Mechanics; Medical; Medicine; Methods; Modernization; Nursing Societies; Outcome; Pain; Pathologist; Patient Care; Patients; Pharyngeal structure; Physicians; Play; Procedures; Professional Organizations; Reporting; Research; Research Priority; Role; Sampling; Savings; Screening procedure; Sedation procedure; Severities; Societies; Soft Tissue Injuries; Solid; Sore Throat; Speech; Standardization; Stenosis; Stroboscopy; Symptoms; Time; Tube; Ulcer; Voice; Wakefulness; associated symptom; base; clinical practice; common symptom; critical care nursing; endotracheal; experience; follow-up; high risk; prevent; prospective; screening; sex; vocal cord

PROJECT SUMMARY Globally, each year 13 - 20 million people become critically ill and are intubated with mechanical ventilation in an intensive care unit (ICU). In the U.S. alone, there are approximately 1 million intubated, with nearly one-third for >5 days. As many as 73% of these patients will sustain laryngeal injury within 1 day of endotracheal tube placement. For >50 years, research has demonstrated a strong association between endotracheal intubation and laryngeal injury, but without considering the role that patient symptoms may play in identifying such injury. Research in laryngeal injury and voice/communication is a research priority among several professional societies, including the American Association of Critical Care Nurses and the Society of Critical Care Medicine. After extubation, patients often have a range of symptoms related to laryngeal injury and voice changes, including hoarseness, loss of voice, throat clearing, sore throat, and vocal fatigue. At present, patients with such symptoms are not identified as being high-risk for laryngeal injury and are often overlooked with the thought that their symptoms will be self-limited. Such a “wait and see” approach to laryngeal injury may defer evaluation for 1 week to 3 months (or longer). Unfortunately, this approach has resulted in some patients experiencing serious, long- term consequences, with some injuries resulting in chronic conditions that may have been avoidable with early evaluation and appropriate intervention. Hence, early identification is important, but there is no standard of practice for referral to a speech-language pathologist or laryngologist after extubation for evaluation. The existing literature has important weaknesses, including patient samples that are heterogeneous, poorly described, and often small-sized. In recent years, clinical practice and associated guidelines have changed to target patient wakefulness during intubation with mechanical ventilation, creating a new and important opportunity to interact with patients to evaluate their symptoms during intubation and soon after extubation. Therefore, the overall goals of this research are to systematically: 1) determine patient symptoms related to orotracheal intubation, both during and after intubation, 2) evaluate laryngeal injury and voice function after extubation using advanced methods of laryngoscopy and perceptual and acoustic voice analyses, and 3) construct a screening tool, based on patient and ICU variables and patient symptoms, to assist in identifying patients with clinically important, post- extubation laryngeal injury. This systematic evaluation of patient symptoms, combined with comprehensive laryngoscopic and voice assessment, will inform the development of a clinical screening tool for use by clinicians in the ICU with the aim of appropriately identifying patients needing further evaluation to reduce the short- and long-term harms of endotracheal tube-related injury on the larynx and voice.

项目摘要 在全球范围内，每年有13-2000万人重病，并在机械通风中插管 重症监护病房（ICU）。仅在美国，大约有100万个插管，近三分之一 > 5天。这些患者中有多达73％将在气管导管后1天内维持喉部损伤 放置。 > 50年以来，研究表明内形插管之间存在很强的关联 和Larryngeal损伤，但没有考虑患者症状在识别这种损伤中的作用。 喉损伤和语音/交流的研究是几位专业的研究优先事项 社会，包括美国重症监护护士协会和重症监护学会。 拔管后，患者经常有一系列与喉损伤和声音变化有关的症状，包括 嘶哑，声音丧失，喉咙清理，喉咙痛和声带疲劳。目前，有此类症状的患者 没有被确定为喉部受伤的高风险，并且经常被认为是 症状将是自限的。喉损伤的这种“等待和看到”方法可能会延期1周 到3个月（或更长）。不幸的是，这种方法导致一些患者经历了严重，长期的 术语后果，导致慢性疾病可能会避免的慢性状况 评估和适当的干预。因此，早期识别很重要，但是没有标准 拔管后，将言语病理学家或喉科医生转介给评估。现有 文献具有重要的弱点，包括异质性，描述不佳的患者样本，并且 近年来，临床实践和相关指南已更改为目标患者 机械通风插管期间的清醒，创造了一个新的重要机会来互动 患者在插管期间和拔管后不久评估其症状。因此，总体目标 这项研究是系统的：1）确定与气管插管有关的患者症状 插管期间和之后，2）使用高级拔管后评估喉损伤和语音功能 喉镜，感知和声音分析的方法，以及3）构建基于筛选工具，基于筛选工具 关于患者和ICU变量以及患者症状，以帮助识别患有临床重要的患者 拔管喉损伤。对患者症状的系统评估，结合了全面 喉镜和语音评估将为临床医生使用的临床筛查工具的开发提供信息 在ICU中，目的是适当地识别需要进一步评估的患者，以减少短暂和 气管管相关损伤对喉和声音的长期伤害。